29D2125937 CLIA NUMBER - ANGELES MEDICAL CENTERS

Laboratory Demographics

CLIA Number: 29D2125937

Facility Name: ANGELES MEDICAL CENTERS

Facility Address:
840 N DECATUR BLVD STE A
LAS VEGAS, NV
ZIP 89107
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Facility Phone Number: 702 333-0110

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1609389394

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	29D2125937
LAB Type	Physician Office
Facility Name	ANGELES MEDICAL CENTERS
Street	840 N DECATUR BLVD STE A
City	LAS VEGAS
State	NV
ZIP	89107
Phone	702 333-0110
CertificateType	4
CertificateEffectiveDate	2/15/2023
CertificateExpirationDate	2/14/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024